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CORAM ALTERNATE SITE SERVICES, INC.
DSH150074 Community Health Network, Inc.
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Covered Entity Details
Entity Name
Community Health Network, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150074
Entity Address
1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219
Medicare Provider Number
150074
Participating Start Date
4/1/2008
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CORAM ALTERNATE SITE SERVICES, INC.
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
11711 NORTH COLLEGE AVENUE
SUITE 125
CARMEL, IN 46032-5601
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Kiley, President
(317) 621-9337
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2019
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